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Potential direct mechanisms involve GLP-1 receptor activation on vascular endothelial cells and possibly immune cells, though human evidence for the latter is variable

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This might arise early in the pathogenesis of T2DM, as one of many risk factors contributing to the initial onset of hyperglycaemia in susceptible individuals, or later, as a consequence of already existing metabolic changes causing increased DPP-4 activity and further exacerbating the deterioration of glycaemic control

Diabetes Sci

John Eng, now retired, occasionally reflects on the journey

Silver Spring, MD: US Food and Drug Administration